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@Kath948381

That depends!  If you need serious medical care then you'll need to be able to fund all, or at least a significant portion, of it yourself.  You are also likely to find that even seemingly-simple things like getting an ambulance to a decent hospital - in one of the big cities, or perhaps just in Sofia - is difficult and expensive. Drug costs can also be significant.

On the other hand, the UK NHS seems to be going to H*ll in a handbasket, so it may not always be the better option.  From my all-too-extensive dealings with the BG health system, I'd say that the NHS is still your best bet.

If you get very frail, BG "hospices" (ie care homes, without the UK connotations attached to the word) are cheaper than their UK equivalents but nowhere near as good, even nowadays.  And you get to pay the full whack here.

Best advice - find yourself a BG toy boy and grow old disgracefully! 😎

Thanks Jimj but what do I do with my UK toyboy who's here with me now? I'm 72 and he's 61 but has an ICD

Treat him to plenty of rakiya, then swipe the battery while he's sleeping it off...😎

@JimJ I understood that Labour removed the 80ish K cap that the Conservatives had imposed on care home contributions in UK so now it’s full whack there too!

So , I don't expect anything for free.

We'll be 67 and 64 when we move. Our intention is to invest whatever we get for our UK house and not touch it unless needed -- that money will only be used for medical care.

I have a toy boy, too, Kath. Mine comes equipped with a pacemaker, which is going to need replacing at some stage. At a minimum we have to be sure we can pay for that privately if needed.

@janemulberry

I think we are in similar situations. Wanting to move but can't yet? I think, if I remember correctly, your' s is due to waiting for pensions? Mine is due to my wife' parents who need us and are both nearly 88.  Hopefully,  one day. Not that I wish them any demise.

I'll make do as well as I can Jane , I've never had a credit card or bothered with living beyond my current means but I'll manage as I'm sure you two will as well.

@alanjolly65

Hubby's mother needing us was one of the reasons we didn't move sooner. We first visited Bulgaria in 2012 and felt it was the place for us, but we were her primary caregivers at the time. One by one her neighbours, all good friends, passed away, so she decided to move to be closer to her surviving friends and adult grandchildren. But by then Brexit had happened, then hubby developed heart problems. He now has his pacemaker, she passed away last year at 96, so we're waiting for my pension so I can get the D visa.

I hope you and your wife can find peace and joy in the waiting time, and also get some respite to have a break in Bulgaria.

@Kath948381

Very wise. We're also careful to live within our means. I'm sure you will do fine.

@Kath948381

Just to add another little "observation" to my other musings on the BG health service, and perhaps give you something to think about.

Pa-in-law (85) had another turn which necessitated an impromptu drive to our village house yesterday, where I discovered that he hadn't eaten any of his meals-on-wheels for a few days but had somehow managed to rip his permanent catheter out some time before (I imagine that any males reading this are crossing their knees right now, just as I did on finding out...😫).  I won't go into details but he was, literally, a bl@@dy mess.

I manoeuvred him into my car and drove him to the nearby town, where the "medical facilities" include a couple of pretty unimpressive hospitals, only one of which has an A&E department.  They "assessed" him and he was then loaded into an ambulance to the other hospital, where they actually have some sort of facilities to treat him. 

It turns out that his haemoglobin level is critically low (2.5 g/dl) and he needs an immediate blood transfusion; however, he isn't getting one.  Why not, I hear you ask. Well, the BG Blood Transfusion Service operates on the basis of "one in, one out", ie the patients (or more usually, their relatives/friends) have to provide one unit of donated blood for every unit administered; I'm too old to donate blood here, and my wife is too sick (they also have lower age limits and even weight limits!) The local Blood Transfusion Centre won't release any blood to the hospital until they've had written confirmation that the same number of units have been donated in the name of the patient - if said patient kicks the bucket in the meantime, that's just tough luck...😨 It has nothing to do with his age or any factor connected to him, it's the same for anyone..

I'm so sorry, @JimJ.

@JimJ

Evening Jim, Sorry to hear that and thanks for the update on bloods that’s eye opening!

Rgds,

ozzy

@JimJ

Very sorry to hear of your father's situation Jim.

You may have already tried and I'm none the wiser, but I wonder whether you could get a transfusion privately, in a private hospital? Or may be they get blood the same way as the public system?

I'll ask my wife when she comes home from work (she's in the medical profession) whether it's any different in the big cities (we're in Varna).

@JimJ

Blood bank levels are quite low everywhere. I am quite healthy to give and would if I could, but not allowed to because Austria doesn't allow Brits to give because of the BSE.

@JimJ
Very sorry to hear of your father's situation Jim.
You may have already tried and I'm none the wiser, but I wonder whether you could get a transfusion privately, in a private hospital? Or may be they get blood the same way as the public system?
I'll ask my wife when she comes home from work (she's in the medical profession) whether it's any different in the big cities (we're in Varna). - @cyberescue1

He's actually in a private hospital - one of the doctors in the public hospital arranged his transfer to a nearby hospital where said doctor coincidentally also works. The treatment's the same but I now have the privilege of paying for it. They still won't/can't do the transfusion and they're going to solve that problem by discharging him over the weekend (or maybe as soon as tomorrow). Blood for all hospitals comes from the National Transfusion Service; we had the same kind of problems when my wife had two major operations earlier this year - luckily, her assistants and their spouses stepped up both times. She will need more blood soon for at least one other major op and we're already looking at ways to get supplies sorted without involving them again. It's easier in the big cities where the "Blood Mafia" does business openly outside most hospitals - if you can afford the current rates (300 leva/unit in Sofia, the last time I checked) but they don't operate in the smaller towns (or at least, not so openly that we can find them). Like many Bulgarians, my wife anyway avoids using their "services" on principle - it gives a whole new meaning to the term "blood money"..

@Kath948381

You certainly don't "have to return" to the UK if you have legal residence here. Many do because of missing family or Tetley's Tea, or wanting access to the NHS, or elderly care. If you're happy here, you can stay for the rest of your life.

If your concern is access to healthcare, I agree that the UK's NHS is familiar and comforting, especially as you know that all necessary treatment will be covered. However, all British pensioners can get an S1, and hence qualify for treatment in the Bulgarian public health system. Additionally, it should be noted that most private hospitals here are affiliated with NHIF and reimbursed by it, so you can get treatment/surgery in a private hospital at a small private surcharge. Moreover, private treatment, even if you pay full price, is very affordable.

I think we'd all agree that the NHS will look after you. However, it should be noted that many things routinely needed by seniors (e.g. knee replacement, hip replacement, spinal surgery, hernia surgery, prostate surgery) have a time-consuming administrative system i.e. GP first, GP referral to hospital for scans/tests, more GP, GP referral to specialist, specialist consult and recommendations, waiting time for operation. It's well known that many folks get extremely frustrated by this and go elsewhere for private treatment. As you're hobbling around on your knackered hip (this happened to my mother), it's not very comforting that your hip will be replaced free of charge... but perhaps in 1-5 years time (depending on demand, and how knackered the specialist thinks it is). You (or I) might not be rich, but being able to decide for ourselves how knackered our hip is, and getting it fixed next week is a wonderful luxury.

To put it in context, the UK will fix it... and will fix it for free,,, but in a long time (unless it's an emergency, which hips/knees/hernias never are). If you're an impatient patient then a UK private hospital (Nuffield, Bupa, etc.) will fix it. I don't know current prices, but, approximately, 15 grand (quids) for a hip, 5 grand for a hernia, 5-10 grand for prostate surgery (depending on what kind). Here in Bulgaria, you have TWO choices for elective surgery: you can use your S1 (and pay a private surcharge) for an op in a private Bulgarian hospital, or you can drive/train for a couple of hours to Istanbul, one of the medical tourism capitals of the world. Both will be far cheaper than the UK private option. Hip (and knee) replacements are covered by NHIF, so you might get one for a grand or so here, and 5-10 in Istanbul. A hernia is also covered by NHIF here, so that's 500-1,000 (vs. 4k in Istanbul). Not all prostate treatment (not that you need to worry about this one!) is covered by NHIF. If it is, another 500, if it isn't maybe less than 3k (vs. 5k ish in Istanbul).

If your concern is elder care, then I imagine it might be tempting to return for a UK care home, if your savings are below the cap (and maybe even if they're above). I don't think we can get paid-for state care here. However, given the low Bulgarian pensions, many care homes here are ludicrously inexpensive (as low as 500 lv per month), so a UK pension would certainly cover it. (How good they are is a different issue, especially given some of the horror stories. But this is an option taken up by many Bulgarians, so they can't all be bad.) Further, there is a disability assessment panel (TELK), so as folks deteriorate their disability assessment may entitle them to some form of care/support/disability pension.

Until you need care, you do what many Bulgarian seniors do in villages which is to muddle on as best they can, for as many years as they can. If you can swap upstairs for downstairs, or swap village house for a small town flat, you might eke out another few years.

I'm a bit younger, so I have few immediate concerns. However, I can't imagine any situation which would make me return to the UK. Indeed, when I do visit my brother I'm shocked by how expensive it is... my pension would make me a pauper there.

I have full cover in NHIF and I pay privately whenever I do any medical stuff. For me, I consider it better than my experiences of the NHS.

Accordingly, I brought my elderly father over a couple of years ago. He was 96 when he arrived, and my overall impression is that I wish I'd tried more forcefully to convince my siblings to let me bring him over sooner. He had very good UK pensions so he had excellent care here from live-in Bulgarian carers (approx. 500 lv per week), and he enjoyed private medical whenever it was needed (courtesy of his S1 and some small out-of-pocket private surcharges). And he swapped a dark, cold, mouldy old house in the middle of nowhere with nothing to do for a light, warm, manageable little city flat with parks and services outside his door. (As it's the UK, his mouldy old dump is a listed building that even with all its problems will still sell for way over half a mil.)

My dad was happier and better cared for here. My brother was able to relax for the first time in many years (he lives and works in London, while our father was several hours away). Our cost of live-in care dropped substantially (the UK was about 1,100 GBP per week, plus another grand per month for agency commission).

Unfortunately, even with tip-top care, he was done for. He was diagnosed (by a nice private hospital in Plovdiv) with metastasized cancer throughout his body and died a couple of months short of his 98th birthday.

I can see how my dad had it relatively easy, given that he had generous UK pensions and a family member to look after him. I don't have either of those things, so, like you, the thought of getting old and infirm (and/or having dementia, like my father) certainly gives me pause. But I still come down very much in favour of persevering with Bulgaria (and I assume it will be in our city flat, rather than our village house).

Separately, I had the local (150m away!) funeral director deal with my father. He organized everything (including body pickup and death certificate), and gave me back a small box of ashes 2 weeks later. It was 2,000 lv, so even at the very end, Bulgaria was still a massive bargain. :-)

@Kath948381
You certainly don't "have to return" to the UK if you have legal residence here. Many do because of missing family or Tetley's Tea, or wanting access to the NHS, or elderly care. If you're happy here, you can stay for the rest of your life.

If your concern is access to healthcare, I agree that the UK's NHS is familiar and comforting, especially as you know that all necessary treatment will be covered. However, all British pensioners can get an S1, and hence qualify for treatment in the Bulgarian public health system. Additionally, it should be noted that most private hospitals here are affiliated with NHIF and reimbursed by it, so you can get treatment/surgery in a private hospital at a small private surcharge. Moreover, private treatment, even if you pay full price, is very affordable.

I think we'd all agree that the NHS will look after you. However, it should be noted that many things routinely needed by seniors (e.g. knee replacement, hip replacement, spinal surgery, hernia surgery, prostate surgery) have a time-consuming administrative system i.e. GP first, GP referral to hospital for scans/tests, more GP, GP referral to specialist, specialist consult and recommendations, waiting time for operation. It's well known that many folks get extremely frustrated by this and go elsewhere for private treatment. As you're hobbling around on your knackered hip (this happened to my mother), it's not very comforting that your hip will be replaced free of charge... but perhaps in 1-5 years time (depending on demand, and how knackered the specialist thinks it is). You (or I) might not be rich, but being able to decide for ourselves how knackered our hip is, and getting it fixed next week is a wonderful luxury.

To put it in context, the UK will fix it... and will fix it for free,,, but in a long time (unless it's an emergency, which hips/knees/hernias never are). If you're an impatient patient then a UK private hospital (Nuffield, Bupa, etc.) will fix it. I don't know current prices, but, approximately, 15 grand (quids) for a hip, 5 grand for a hernia, 5-10 grand for prostate surgery (depending on what kind). Here in Bulgaria, you have TWO choices for elective surgery: you can use your S1 (and pay a private surcharge) for an op in a private Bulgarian hospital, or you can drive/train for a couple of hours to Istanbul, one of the medical tourism capitals of the world. Both will be far cheaper than the UK private option. Hip (and knee) replacements are covered by NHIF, so you might get one for a grand or so here, and 5-10 in Istanbul. A hernia is also covered by NHIF here, so that's 500-1,000 (vs. 4k in Istanbul). Not all prostate treatment (not that you need to worry about this one!) is covered by NHIF. If it is, another 500, if it isn't maybe less than 3k (vs. 5k ish in Istanbul).

If your concern is elder care, then I imagine it might be tempting to return for a UK care home, if your savings are below the cap (and maybe even if they're above). I don't think we can get paid-for state care here. However, given the low Bulgarian pensions, many care homes here are ludicrously inexpensive (as low as 500 lv per month), so a UK pension would certainly cover it. (How good they are is a different issue, especially given some of the horror stories. But this is an option taken up by many Bulgarians, so they can't all be bad.) Further, there is a disability assessment panel (TELK), so as folks deteriorate their disability assessment may entitle them to some form of care/support/disability pension.

Until you need care, you do what many Bulgarian seniors do in villages which is to muddle on as best they can, for as many years as they can. If you can swap upstairs for downstairs, or swap village house for a small town flat, you might eke out another few years.

I'm a bit younger, so I have few immediate concerns. However, I can't imagine any situation which would make me return to the UK. Indeed, when I do visit my brother I'm shocked by how expensive it is... my pension would make me a pauper there.

I have full cover in NHIF and I pay privately whenever I do any medical stuff. For me, I consider it better than my experiences of the NHS.

Accordingly, I brought my elderly father over a couple of years ago. He was 96 when he arrived, and my overall impression is that I wish I'd tried more forcefully to convince my siblings to let me bring him over sooner. He had very good UK pensions so he had excellent care here from live-in Bulgarian carers (approx. 500 lv per week), and he enjoyed private medical whenever it was needed (courtesy of his S1 and some small out-of-pocket private surcharges). And he swapped a dark, cold, mouldy old house in the middle of nowhere with nothing to do for a light, warm, manageable little city flat with parks and services outside his door. (As it's the UK, his mouldy old dump is a listed building that even with all its problems will still sell for way over half a mil.)

My dad was happier and better cared for here. My brother was able to relax for the first time in many years (he lives and works in London, while our father was several hours away). Our cost of live-in care dropped substantially (the UK was about 1,100 GBP per week, plus another grand per month for agency commission).

Unfortunately, even with tip-top care, he was done for. He was diagnosed (by a nice private hospital in Plovdiv) with metastasized cancer throughout his body and died a couple of months short of his 98th birthday.

I can see how my dad had it relatively easy, given that he had generous UK pensions and a family member to look after him. I don't have either of those things, so, like you, the thought of getting old and infirm (and/or having dementia, like my father) certainly gives me pause. But I still come down very much in favour of persevering with Bulgaria (and I assume it will be in our city flat, rather than our village house).

Separately, I had the local (150m away!) funeral director deal with my father. He organized everything (including body pickup and death certificate), and gave me back a small box of ashes 2 weeks later. It was 2,000 lv, so even at the very end, Bulgaria was still a massive bargain. :-) - @gwynj

I know of people who waited a month just for an MRI in London. Others are waiting for 2 years to have a hip replacement. 18 hours in A&E. If I fall sick in the UK, I  would rather get treated back over here, of course, depending on how sick I was.

@GwynJ Condolences on your Dad's passing. I'm so sorry. Bringing him to Bulgaria was such a good choice for him, and for all your family to know he had the best possible quality of life.

@Kath948381

I think this depends on you individually. When we had to return from France I was heartbroken and still get homesick for it. I don’t really recognise the UK as my home at all.

I appreciate health issues may be an issue but would it be better in UK? I am not so sure. I had a bilateral mastectomy for my third time with cancer over a year ago. I have not been contacted for any check ups since. We moved to my daughters in N.Wales while finalising the Visa D and can’t see a GP. My daughter has been unable to register with one for four years.

We are 73 and 68 and are only just moving to Bulgaria.

So I guess it’s your reasoning to go back.

Jean, I'm so sorry you've experienced such challenges, both with your health and with accessing care.

I do agree that Brits who return to the UK for the NHS may find they're no better off than they would have been in Europe. Many of us still in the UK are finding it almost impossible to get NHS health care. In our town, the GPs simply aren't seeing patients. The day's quota of appointments are supposedly all gone within minutes of the surgery opening. Everyone who the AI triage system says should be seen by a GP is told to go to an NHS walk-in-centre -- the nearest one is two towns away. Queuing for an hour at a pharmacy to get routine prescription or even over-the-counter medication is "normal".  Follow-up after hospital care is delayed or non-existent.  Social care for those entitled to free care is generally inadequate (two 15 minute visits a day to meet all a disabled older person's care needs!), and the entitlement to free social care is being whittled away.

Hubby will need ongoing medical follow-up for a life-long chronic condition that causes multi-system issues, including problems with his heart he was first diagnosed with aged 30 that eventually led to him needing the pacemaker (getting that was a saga in itself, including years of delays, follow-up that never happened, misdiagnoses, prescriptions for medications that are contraindicated with his underlying condition...).  But after so many NHS mess-ups including downright dangerous ones, we're fairly certain that though accessing health care in Bulgaria, especially in a smaller village, will have it's own challenges, it is likely to be easier than what we have now in the UK. By necessity, we've become extremely good at self-managing chronic health issues, and thankfully with at least one the issues that made him very seriously ill in the past he's found ways to control it for himself.

I'm sure Bulgarian health care can be very "third world" in places, but we've both had third-world experiences in the NHS, too so I doubt it will be much worse. Social care may be more of a challenge. I can imagine that we may need to move to town and pay for care if the village house becomes unmanageable and we're not able to care for ourselves. But I can't imagine I'd want to move back to the UK.

Sorry to hear about your father in law Jim.

I find this blood situation really scary.

What happens if one is involved in a car accident & needs a transfusion? I mean one could ask friends to donate but people have different blood groups .. I find it unsettling the knowledge that there is no blood bank.

I mentioned to our GP yesterday that we used to get sms messages every 4 months in South Africa asking us to donate and did something similar happen here? He said donating blood is not common at all.

@AshAdu

My understanding is that there IS a blood bank, but they don't release blood unless they get a unit back. The blood group of the donor isn't an issue, provided someone donates a unit of blood in your name, you can get a unit of suitable blood from the blood bank. You don't necessarily get the blood that a friend or family member donates for you, because it probably won't be a good match.

I can see it could be a huge problem, though, in either emergency situations or when someone needs regular transfusions. My elderly mother back in Australia has a blood cancer and a bleeding problem and her haematologist arranges a blood transfusion for her every couple of weeks. In Bulgaria it would be a big issue getting enough donors to arrange that for her. But I doubt someone her age would be offered blood at all here in the UK, her only option would be palliative care and she'd be dead in a month.

@AshAdu

It IS really scary! My wife has colorectal cancer and has had one very major operation (read "followed by a week in intensive care in an induced coma") followed by intensive radio- and chemo-therapy, then a failed colostomy reversal a year later, which led to a bowel-bladder fistula.

That all took a LOT of blood (she also has thalassemia, carriers of which are relatively common across the Balkans) and we ran through the entire gamut of the BG Blood Sourcing Comedy (or perhaps Tragedy is more apropos): the bloodsucking Blood Mafia, the balancing act of who do I know that fits the age/weight/health criteria that I can try a bit of emotional blackmail on? It's lucky that she has generous colleagues and assistants, and even more lucky that the Blood Transfusion Service had some stocks of her apparently rare blood group.

We'd already been through this before, when her father was being operated on for cancer in a seriously antiquated hospital in Sliven; the situation there is even worse than in Sofia...but at least the Blood Mafia were hanging around the Haematology department, waiting for desperate people to cough up blood money.

We have managed to drum up enough blood for the transfusion to be given to my father-in-law and  he's being bounced out of hospital tomorrow, even though his condition would still apparently merit Intensive Care in the UK. 

We're ferrying him to a care home/hospice tomorrow; the same one that his wife has already been in for several months. They won't be together of course, the sexes are kept apart here - and to be frank, the cost is pretty crippling. I don't know what the drive will be like: the doctor tells us that he's off his head when he's awake but he can walk a few steps, and can therefore travel by car instead of by ambulance.

If you didn't know it, ambulances here are private, so make sure your insurance covers a long ride or be prepared to fork out several hundred leva, IF you can even find an ambulance prepared to drive outside their home oblast..and don't expect even Emergency Ward 10 standard vehicles or anything resembling a paramedic (you'll be lucky to get more than a single person, who's the driver), or boring fripperies like a real trolley, medicines/drugs, resuscitation kit etc.

Yes, my dismal view of the medical system here has plunged even lower; by and large, Bulgarians have a pretty fatalistic view of their own system, and just hope for the best despite the appalling service they get. Even the very best you can get here is far below what you'd expect in most European countries - as I've mentioned before, during a previous bout of bad health we took my father-in-law to what purports to be the best private hospital in the country. I foolishly assumed that our participation would be limited to paying the hefty bill - I wasn't expecting to be invited to change his "pampers", clean him up, or change his clothing and bedding into the bargain!

@JimJ

PS I forgot to mention that as well as having to source the blood yourself, you also get charged for the transfusion...not a fortune, but still 140 leva or, to conform to Euro regulations, €71.58 😎

The "private stay" after the maximum permitted stay mandated by the BG health service was minimal, but so was the care: his blood- and urine-sodden mattress and bedclothes weren't changed once in the week or so he was there...when we picked him up this morning he really needed a good hosing-down in the garden!

I hope the transfer went okay. @JimJ. What you're experiencing from the healthcare system really is horrendous.